ArticleThe Pan African medical journal2020
Universal health insurance in Rwanda: major challenges and solutions for financial sustainability case study of Rwanda community-based health insurance part I.
Article in The Pan African medical journal, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 1 of them a synthesis that pooled it.
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Who cites it
37 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Facilitators and barriers of lung cancer screening participation: umbrella and systematic review of the global evidence.BMC public health · 2025Pooled it
- Advancing forensic psychiatry in Rwanda: lessons learned and challenges.Global health action · 2026Article
- Stakeholder perspectives on the financial sustainability of community-based health insurance schemes in North Shewa Zone, Ethiopia: a qualitative study.Scientific reports · 2026Article
- Neural tube defects burden from 1992 to 2021: a global, regional, and national age-period-cohort analysis of disability-adjusted life years.BMC pediatrics · 2026Article
- All-Cause Mortality in Persons With HIV-HBV Co-Infection Treated for HBV in Rwanda: A Population-Based Cohort Study.Journal of viral hepatitis · 2026Article
- Research gaps on universal health coverage in the South African context and other low and middle-income countries; putting things into perspective: a scoping review.BMC health services research · 2026Article
- From Aid Dependency to Self-Reliance: Lessons From Sierra Leone and Rwanda's Strategies for Eliminating Preventable Blindness in Africa: A Perspective Study.Health science reports · 2026Article
- Hepatitis B treatment response and factors associated with HBV treatment success: A population-based study in Rwanda.Hepatology communications · 2026Article
- Telemedicine implementation and healthcare utilization in Rwanda: interrupted time series of babyl digital health services from 2015 to 2024.BMC primary care · 2026Article
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- Continuity of maternal and newborn health service provision among private sector players following donor transition. Hope amidst challenging implementation experiences in Uganda.Globalization and health · 2025Article
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- Cost comparison of laparoscopic versus open surgery for common procedures in Rwandan teaching hospitals.Surgery open science · 2025Article
- Countdown to 2030: overview of current and planned health financing reforms for universal health coverage in the WHO African Region.Journal of global health · 2025Article
- Strategic analysis of financing communicable diseases in Afghanistan.Cost effectiveness and resource allocation : C/E · 2025Article
- An evaluation of the impacts of health insurance coverage on wealth stratification in some selected sub-Saharan countries.Health economics review · 2025Article
- Moving toward universal health coverage with a national health insurance program: A scoping review and narrative synthesis of experiences in eleven low- and lower-middle income countries.PLOS global public health · 2025Article
- Barriers to health insurance uptake in Rwanda: a nationwide cross-sectional survey.The Pan African medical journal · 2025Article
- Factors associated with client satisfaction and implementation challenges for community-based health insurance in Ethiopia: beneficiaries' perspectives.Frontiers in public health · 2025Article
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3 authors.
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Abstract
introductionUniversal Health Coverage (UHC) has engaged attention of policy makers at both global and country levels. UHC is one of three strategic priorities of World Health Organization's (WHO) general program of work for 2019-2023, and it is then a global health priority. Rwanda Community-Based Health Insurance is considered the vehicle for UHC and Universal Health Insurance in Rwanda. CBHI was officially introduced in 1999/2000 and through 2011/2012 Rwanda was not far from effective UHC. However, since then, CBHI faced chronic financial deficit. This study aims to assess challenges facing Community-Based Health Insurance financial sustainability and to propose indicative solutions.
methodsquantitative, qualitative, analytical, longitudinal (2011-2018) and documentary mixed methods were applied. One National Pooling Risk (100%), 15 Community-Based Health Insurance districts (50%) and 60 Community Based Health Insurance sections (13.33%) were randomly selected and included in the study. To assess major challenges, "analyzing qualitative data G3658-6 approach" and "prioritization hanlon method" were used.
resultsthe study highlighted five major challenges: (i) disproportionate risk-equalization in the social health insurance contributory system; (ii) unit cost exceeding individual income (premium plus other revenues and subsidies); (iii) imperfection in funding mobilization and recovery; (iv) cost-escalation; (v) diseconomy of scale; and the study proposed indicative solutions including injection of additional funding and shifting from current fee-for-service payment to fully active strategic purchasing mechanisms as accompanying measures.
conclusionCBHI financial sustainability is achievable, but this is contingent upon persistence of political commitment efforts to achieve UHC, correction of highlighted imperfections and injection of additional funding to allow Rwanda Community-Based Health Insurance to meet and/or exceed its cost in the long-term.
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